Impact of Dedicated Care Coordination on Access to Multidimensional Support Services in Young-Onset Colorectal Cancer: A Pragmatic Trial

PURPOSE: The incidence of young-onset colorectal cancer is increasing, and affected patients experience distinct challenges. Patients with young-onset colorectal cancer may benefit from a dedicated care coordinator that systematically assesses their unmet needs and facilitates referrals to multidimensional specialty support services. METHODS: In this pragmatic trial, we assigned newly diagnosed colorectal cancer patients aged <50 years who presented to a tertiary academic institution between 2023-2025 to standard care vs. standard care plus additional encounter(s) with a dedicated young-onset colorectal cancer care coordinator. Patient-reported concerns and distress were collected at initial presentation. The primary endpoint was utilization frequency of support services. Multivariable regression identified predictors of service utilization. RESULTS: Among 1,250 patients with young-onset colorectal cancer (mean age 42.8±6.0 years; 45.4% female), 46.3% had rectal cancer. Emotional concerns were most common (41.0%), followed by physical (36.1%), practical (27.8%) and social (9.4%) concerns. Overall, clinically significant distress (distress score ≥4) was reported by 27.4%. The young-onset colorectal cancer coordinator successfully established contact with 604 individuals. Unmet service needs were reported by 39.1% in the intervention group, of whom 80.5% subsequently accessed corresponding support services. Patients who established contact with the young-onset colorectal cancer coordinator were more likely to access support services (72.5% vs.44.7%, p<0.001). On multivariable analysis, coordinator contact (aOR 1.48, 95%CI 1.22-1.80), rectal cancer diagnosis (aOR 1.36, 95%CI 1.13-1.62), and clinically significant distress (aOR 1.23, 95%CI 1.01-1.50) predicted greater multidimensional service utilization. CONCLUSION: Patients with young-onset colorectal cancer experience substantial emotional concerns and unmet needs. Proactive integration of a dedicated care coordinator was associated with significantly increased utilization of multidimensional support services. This pragmatic trial supports a personalized, needs-driven care delivery model, that integrates patient-reported outcomes as the basis for patient-centric cancer care.